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General NPI Number Information
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NPI Number | 1568470227
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Entity Type | Organization
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Legal Business Name | LAPAROSCOPY BARIATRICS & SURGERY PA
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 11/17/2016
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Provider Practice Location Address
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Address Line | 2501 PARKVIEW DR SUITE 560
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City | FORT WORTH
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State | TX
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Zip | 76102-5824
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Country | US
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Telephone | 817-850-1100
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Fax | 817-870-2553
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Provider Business Mailing Address
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Address Line | 2501 PARKVIEW DR SUITE 560
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City | FORT WORTH
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State | TX
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Zip | 76102-5824
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Country | US
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Telephone | 817-850-1100
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Fax | 817-850-1104
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MYLA R PLENERT
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Credential |
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Telephone | 817-916-4699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | H7229
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License Number State | TX
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